The present invention relates to a body liquid drainage device, particularly a urinary drainage device. It also relates to a method for preventing counter-current infection from such devices.
Artificial drainage of urine from the bladder is necessary when incontinence exists or when the natural process for draining the bladder is impaired or interrupted. Thus, for example, natural drainage may be interrupted in the male by pre-operative retention of urine due to an enlarged prostate or by post-operative impairment of sphincter function due to surgery of prostatic tissue. Similarly, in the female, natural drainage can be interrupted after gynaecological surgery.
Artificial drainage can be achieved by introducing a tube (a catheter) into the bladder via the urethra and the catheter may be withdrain after emptying of the bladder. Alternatively, it may be retained and connected to a length of tubing attached to a drainage bag so that the urine can be drained continuously.
In a post-operative situation a suitable drainage system is critical to the successful recovery of the patient, and in order to maintain efficient drainage, usually under gravity, the catheter and tubing must both be correctly placed and correctly maintained in position so that there is no impairment of the flow of urine. If the flow of urine is impaired or shut off, retention of urine in the bladder results, with subsequent retrograde invasion of the ureters and kidneys by bacteria passing up from the bladder.
For overnight urine drainage in a patient with either a catheter or an external appliance, it is important that the overall drainage capacity of any system employed should be sufficient to accommodate the amount of urine likely to drain from the patient while asleep. In that situation, it has been generally known to utilise one of the following systems:
For day drainage the semi-ambulant/ambulant patient is provided each morning with a leg bag secured to the patient. Each evening the leg bag is removed and the patient is connected for the night to a bedside drainage bag on a stand. This system is acceptable in that the leg bag can be worn discreetly and the patient can be relatively mobile during the day. However, the system involves the disadvantage of necessitating the breaking of the closed drainage circuit each morning and each evening, with consequent risk of contamination each time the circuit is broken. In this respect it is to be noted that at least 30% of all hospital acquired infections are urinary tract related.
Alternatively, the patient may be permanently connected to a bedside drainage bag. This avoids breaking the closed circuit twice daily, but leaves the patient to carry a large bag and stand about if mobility is required, which makes rehabilitation difficult. Furthermore, use of the night drainage bag during the day acts as a visual reminder to the patient of his or her current condition and increases psychological trauma, especially in the case of more mobile patients who are ambulant or in wheelchairs.
It is now more common to permit patients to wear their leg bag at night and to connect the leg bag outlet, rather than the catheter, to a bedside disposable night bag (described in European Patent Application No. 85301059.3).
This eliminates the need for disconnecting the leg bag from the catheter or the like, with consequent connection of a bedside drainage bag, thus reducing the likelihood of urinary tract infection due to contamination when the closed system is broken.
The third technique described above is now the most preferred method of night drainage and has encouraged greater use than ever of leg bags for day drainage, where previously hospital infection control policies may have prevented the use of leg bags as it implied breaking the closed circuit twice daily to convert to and from a night bag. However, this system is not entirely satisfactory for the reasons summarised below:
1. Handling of the junction between the leg bag outlet tap and the night bag increases the risk of hand contamination of urine.
2. The risk of cross-infection is increased through handling.
3. The task of handling the system has to be carried out by a nurse or nursing auxilliary and therefore consumes other people's time and in any event does not encourage self-help by the patient.
4. If the procedure is not carried out correctly, serious problems can arise, namely if the tap of the leg bag is not opened to drain at night or closed after disconnection in the morning, leakage of urine will occur. Similarly, if a good connection is not made between the leg bag outlet tap and the night bag, leakage of urine will occur.
5. The presence of a night drainage bag placed at the bedside does not help ease the psychological trauma of the patient.
6. Stocks of leg bags and night bags must be available at all times, because the night bag is discarded with its contents each morning.